Multimodal Treatment of Gastric Cancer: Surgery, Chemotherapy, Radiotherapy, and Timing

Surgery is no more alone in the scenario of gastric cancer treatment since many years. Although the encouraging results of adjuvant chemotherapy obtained in Japan with S-1 were not achieved in Western countries, a novel approach, after the results of MAGIC trial, published in 2006, has been introduced by means of perioperative, or just preoperative, chemotherapy in the West, with many trials ongoing. Radiotherapy has been used from many years until now in the USA, with good results, and is part of many schedules in Europe as well. Chemotherapy has been proposed even in an intraperitoneal setting with hyperthermia, after extensive resection and peritonectomy (HIPEC). Novel drugs, known as immunological, have also been introduced, following gastric cancer molecular genetics studies , which appears to be a new frontier of translational research, as for many other cancers, in order to tailor a specific treatment to each case. Similar to that achieved with the management of col-orectal and esophageal cancers, multimodal treatment is therefore mandatory, to date, for gastric cancer, but timing, type of therapies, and schedules seem to be a puzzle yet. The present special issue tries to span the diverse and wide possibilities of gastric cancer treatments and topics, from endoscopic dissection to HIPEC, without foregoing molecular genetics aspects, which are all part of nowadays clinical practice of surgical oncologists. Prominent interest is, obviously, in results in terms of overall survival with different approaches as well as complete response to preoperative treatments. Nonetheless, the impact of multimodal treatments on surgical perioperative complications and side effects should be taken into account, considering the aging of oncologic patients. One paper addresses a mini-invasive gastric cancer treatment , namely, submucosal dissection (ESD), which is a recent upgrade of the former mucosectomy. This technique is routine practice, when indicated, for early gastric cancers in Japan, while it is still not very well diffused in Western countries. The paper shows how this procedure is particularly helpful in elderly patients, without compromising the necessity of a subsequent gastrectomy, if needed. Another paper shows the mechanisms of cisplatin-induced apoptosis and of cisplatin sensitivity. The authors also identify the molecular substrate called bridging integra-tor 1 (BIN1) to act as a potent predictor of cisplatin sensitivity in gastric cancer treatment. The importance of the trans-lational research on clinical practice and patients selection for tailored chemotherapy is highlighted. One of the papers sheds light on an exquisitely surgical issue, which …